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http://ccsa.edu.sv/study.php?online=thesis-and-dissertation thesis and dissertation Bhatt dl, hulot js, moliterno dj, harrington ra. Antiplatelet and anticoagulation therapy for acute coronary syndromes. Circ res. 2014;114(12):1929–1943. 23. Sofi f, giusti b, marcucci r, gori am, abbate r, gensini gf. Cytochrome p450 2c19*2 polymorphism and cardiovascular recurrences in patients taking clopidogrel. A meta-analysis. Pharmacogenomics j. 2011;11(3):199–206. 24.

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twelve years a slave essay D. The catheter is inserted while gentle traction is exerted on the cord. Once the catheter is in the vein, one should try to slide the catheter cephalad just under the skin, where the vein runs very superficial. If the catheter is being placed for emergency (vascular access) or for an exchange transfusion, it should be advanced only as far as is necessary to establish good blood flow (usually 2-5 em). If the catheter is being used for continuous infusion or to monitor central venous pressure, it should be advanced through the ductus venosus into the inferior vena cava and its position verified by x-ray. E. Only isotonic solutions should be infused until the position of the catheter is verified by x-ray studies. If the catheter tip is in the inferior vena cava, hypertonic solutions may be infused. F. H no other access is available, catheters may be left in place for up to 14 days. After which the increased risk of infectious or other complications is excessive. In very low birth weight infants, our practice is to change access to a peripherally placed central venous catheter by 10 days whenever possible. D. Multiple--lumen catheters for umbilical venous catheterization 1. Indications.

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http://manila.lpu.edu.ph/about.php?test=proposal-writing-services proposal writing services 2nd ed. Washington, dc. American psychiatric association. 2009. [cited 2011 oct 10]. Available from Psychiatryonline. Com/content. Aspx?. Aid=58560. Accessed september 12, 2011. 43. Van apeldoorn fj, van hout wj, mersch pp, et al. Is a combined therapy more effective than either cbt or ssri alone?. Results of a multicenter trial on panic disorder with or without agoraphobia. Acta psychiatr scand. 2008;117(4):260–270. 44. Ferguson jm, khan a, mangano r, et al. Relapse prevention of panic disorder in adult outpatient responders to treatment with venlafaxine extended release. J clin psychiatry. 2007. 68(1):58–68. 45. Rickels k. Alprazolam extended release in panic disorder. Expert opin pharmacother. 2004;5(7):1599–1611. 46.

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ptlls help assignments Magnetic resonance imaging no evidence o etal harm gadolinium in animal studies, association with abortion and developmental abnormalities. Fda class c use o gadolinium should be avoided unless it may result in changes in management that would a ect the patient or etus. Data from american college of obstetricians and gynecologists (acog). Guidelines for diagnostic imaging during pregnancy. Acog committee opinion no. 299. Obstet gynecol 2004;104:647–651. And american college of radiology (acr) – society for pediatric radiology (spr) practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. 2013. (ie, without gadolinium) mr angiography (mra) and mr venography (mrv) is pre erable. Practice guidelines regarding the sa ety o imaging protocols in pregnancy are summarized in table 4-1. In addition, one should have a low threshold or urinalysis or protein in women above 20 weeks o pregnancy and hypertension, given the signi cant implications o a positive result in the management o the patient. Finally, a lumbar puncture (lp) with opening pressure should be per ormed i the a orementioned investigations do not yield a diagnosis and entities such as idiopathic intracranial hypertension (iih) or meningitis are being considered. Ca se 4-1 (continued) given the concerning red ags, urgent neuroimaging was obtained, with an mri with tof mra/mrv, which revealed a superior sagittal sinus (sss) and right transverse and sigmoid sinus thrombosis (figure 4-3). Anticoagulation with heparin was initiated (see 35 women’s issues in h ospit a l neur ology section 3.2.6), and the patient’s headache improved. Formal visual eld testing was arranged. Had the tof mra/mrv been equivocal, a cta/ ctv may have been per ormed to de nitely rule out venous thrombosis (table 4-1). Had the mrv been normal, lp with opening pressure would have been indicated to rule out iih, which may present during pregnancy. Impact of pregnancy on primary headaches de novo migraine during pregnancy is rare. There ore, new-onset headache with migraine characteristics during pregnancy should typically prompt a workup. Improvement o migraine is common but not the rule, and may be more noticeable in the second and third trimesters, especially in women with menstrual migraines. Acute management of migraine attack in the pregnant woman nonsteroidal anti-in ammatory drugs may be used be ore 32 weeks gestational age. Acetaminophen 650–1000 mg is sa e in pregnancy and e ective or symptomatic relie .13 it may be taken with ca eine 40–50 mg. Opioids should be used with caution, as codeine has recently been implicated in midline de ects. Riptans should be avoided (fda category c – see table 4-2 or de nitions), along with ergotamines. (fda category x). T e anti-emetics ondansetron 4–8 mg and metoclopramide 10 mg may be used (fda category b). Steroids (dexamethasone fda category c due to increased incidence o cle palate) may be used in the second or third trimester i the acute attack is re ractory to the a orementioned interventions. One should also monitor or potential medication overuse headache. Menopausal women x perimenopausal migraines perimenopause is characterized by an increased variability in length and requency o menstrual cycles, leading to uctuations in estrogen levels. Migraines typically worsen during the perimenopausal transition and then signi cantly improve a er menopause.6 hormone replacement therapy (hr ) is an important exogenous hormonal actor to take into consideration.

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